title: Successful management of occult pneumothorax without tube thoracostomy despite positive pressure ventilation.
abstract: The objective of this study was to determine whether tube thoracostomy can be safely avoided in a subset of patients with blunt occult pneumothorax. A retrospective review was performed. Management without tube thoracostomy was attempted for 59 occult pneumothoraces and was successful in 51 (86%). Observation was successful in 16 of 20 occult pneumothoraces (80%) exposed to positive pressure ventilation within 72 hours of admission. Eight delayed tube thoracostomies were required an average of 19.7 hours post admission. Patients who failed observant management had more significant physiologic derangement on admission (revised trauma score 6.96 vs 7.66, P = 0.04), were more likely to have significant multisystem trauma (88% vs 37%, P = 0.007), but were not more likely to require positive pressure ventilation (PPV) (50% vs 31%, P = 0.31). This study demonstrates that a subset of patients with blunt occult pneumothorax requiring positive pressure ventilation may be safely managed without tube thoracostomy.
authors.affiliation: University of California, Irvine, Department of Surgery, Division of Trauma Critical Care, Burns and Acute Care Surgery, Orange, California, USA.
authors.forename: Cristobal
authors.initials: C
authors.lastname: Barrios
authors.forename: Tuan
authors.initials: T
authors.lastname: Tran
authors.forename: Darren
authors.initials: D
authors.lastname: Malinoski
authors.forename: Michael
authors.initials: M
authors.lastname: Lekawa
authors.forename: Matthew
authors.initials: M
authors.lastname: Dolich
authors.forename: Stephanie
authors.initials: S
authors.lastname: Lush
authors.forename: David
authors.initials: D
authors.lastname: Hoyt
authors.forename: Marianne E
authors.initials: ME
authors.lastname: Cinat
mesh_terms: D000328:Adult; D015505:Chest Tubes; D000075202:Contraindications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D011175:Positive-Pressure Respiration / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D013907:Thoracostomy / Q000295:instrumentation; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000000981:diagnostic imaging